Provider Demographics
NPI:1124412671
Name:ENTERPRISE INTERNAL MEDICINE LLC
Entity Type:Organization
Organization Name:ENTERPRISE INTERNAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:GERBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-808-8763
Mailing Address - Street 1:1507 PARK CENTER DR
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-5795
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:407-286-4167
Practice Address - Street 1:1507 PARK CENTER DR
Practice Address - Street 2:SUITE 1A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5795
Practice Address - Country:US
Practice Address - Phone:407-808-8763
Practice Address - Fax:407-286-4167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 66305207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty